Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence.

BACKGROUND: Few diet quality indices have been developed and validated for use among children and adolescents. Additionally, many available indices require completion of burdensome dietary assessments. OBJECTIVES: We aimed to calculate and evaluate the performance of a modified version of the food-based Prime Diet Quality Score (PDQS) derived from different diet assessment methods conducted at 4 time points in a single study population from childhood through adolescence. METHODS: Among 1460 child participants in the Project Viva cohort, we calculated the PDQS in early and mid-childhood and early and mid-adolescence using dietary data obtained from food frequency questionnaire (early childhood: parent report), PrimeScreen (mid-childhood: parent report; early adolescence: self-report) and 24-h recall (mid-adolescence: self-report). We evaluated construct and relative validity and internal reliability of the score in each life stage. RESULTS: The PDQS showed a range of scores at all life stages and higher scores were associated with intake of many health-promoting macronutrients and micronutrients (e.g., protein, fiber, and vitamins) in early childhood and mid-adolescence. The PDQS performed similarly to the Youth Healthy Eating Index/Healthy Eating Index (Spearman r = 0.63-0.85) in various assessments. Higher PDQS was associated with expected characteristics including more frequent breakfast eating, family dinners, and vigorous physical activity; with less frequent TV viewing and fast food intake; and with more sleep and higher maternal diet scores during pregnancy. Cross-sectional associations of the PDQS with various anthropometric measurements and biomarkers were inconsistent but generally in the expected directions (e.g., higher PDQS associated with lower triglycerides and insulin and higher HDL cholesterol). Internal reliability was consistent with what has been found for other diet quality indices. CONCLUSIONS: The PDQS can be calculated from data collected using different and brief dietary assessment methods and appears to be a valid and useful measure of overall diet quality in children and adolescents. Project Viva was registered at clinicaltrials.gov as NCT02820402.

Adding salt to food at table as an indicator of gastric cancer risk among adults: a prospective study.

BACKGROUND: While dietary salt intake has been linked with gastric cancer risk in Asian studies, findings from Western populations are sparse and limited to case-control studies. Our aim was to evaluate the frequency of adding salt to food at table in relation to gastric cancer risk among UK adults. METHODS: We evaluated associations between the frequency of adding salt to food and the risk of gastric cancer in the UK Biobank (N = 471,144) using multivariable Cox regression. Frequency of adding salt to food was obtained from a touchscreen questionnaire completed at baseline (2006-2010). 24-h urinary sodium excretion was estimated using INTERSALT formulae. Cancer incidence was obtained by linkage to national cancer registries. RESULTS: During a median follow-up period of 10.9 years, 640 gastric cancer cases were recorded. In multivariable models, the gastric cancer risk among participants reporting adding salt to food at table "always" compared to those who responded "never/rarely" was HR = 1.41 (95% CI: 1.04, 1.90). There was a positive linear association between estimated 24-h urinary sodium levels and the frequency of adding salt to food (p-trend <0 .001). However, no significant association between estimated 24-h urinary sodium with gastric cancer was observed (HR = 1.19 (95% CI: 0.87, 1.61)). CONCLUSIONS: "Always adding salt to food" at table was associated with a higher gastric cancer risk in a large sample of UK adults. High frequency of adding salt to food at table can potentially serve as a useful indicator of salt intake for surveillance purposes and a basis for devising easy-to-understand public health messages.

Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS).

BACKGROUND: Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES: We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS: Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS: We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS: The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.

Diet quality and all-cause mortality among US adults, estimated from National Health and Nutrition Examination Survey (NHANES), 2003-2008.

OBJECTIVE: We assessed the ability of the Prime Diet Quality Score (PDQS) to predict mortality in the US population and compared its predictiveness with that of the Healthy Eating Index-2015 (HEI-2015). DESIGN: PDQS and HEI-2015 scores were derived using two 24-h recalls and converted to quintiles. Mortality data were obtained from the 2015 Public-Use Linked Mortality File. Associations between diet quality and all-cause mortality were evaluated using multivariable Cox proportional hazards models, and predictive performance of the two metrics was compared using a Wald test of equality of coefficients with both scores in a single model. Finally, we evaluated associations between individual metric components and mortality. SETTING: A prospective analysis of the US National Health and Nutrition Examination Survey (NHANES) data. PARTICIPANTS: Five-thousand five hundred and twenty-five participants from three survey cycles (2003-2008) in the NHANES aged 40 years and over. RESULTS: Over the 51 248 person-years of follow-up (mean: 9·2 years), 767 deaths were recorded. In multivariable models, hazard ratios between the highest and lowest quintiles of diet quality scores were 0·70 (95 % CI 0·51, 0·96, Ptrend = 0·03) for the PDQS and 0·77 (95 % CI 0·57, 1·03, Ptrend = 0·20) for the HEI-2015. The PDQS and HEI-2015 were similarly good predictors of total mortality (Pdifference = 0·88). CONCLUSION: Among US adults, better diet quality measured by the PDQS was associated with reduced risk of all-cause mortality. Given that the PDQS is simpler to calculate than the HEI-2015, it should be evaluated further for use as a diet quality metric globally.

Feasibility and sustainability of dietary surveillance, Bosnia and Herzegovina.

National dietary surveillance systems are necessary for monitoring people's intake of foods and nutrients associated with health and disease, and for implementing national and global dietary goals. However, these systems do not exist in many low- and middle-income countries. The development of a model of dietary surveillance for Bosnia and Herzegovina, described here, provides insights into the feasibility and sustainability of dietary surveillance systems in resource-constrained settings and illustrates the challenges involved. In 2016, a year-long dietary survey was initiated in collaboration with the country's Institute for Statistics using a subsample of households that participated in the 2015 national Household Budget Survey. Interviewers collected lifestyle, anthropometric and health data and participants answered two 24-hour dietary recall questionnaires. The survey included a representative sample of 853 participants and was performed efficiently by a small team of highly motivated, well-trained staff. Conducting a high-quality dietary survey was found to be feasible despite constrained resources. In addition, the ability to link dietary intake and regular household survey data provided an effective way of associating dietary variables with socioeconomic determinants of health. This dietary survey, the first conducted by an official institution in Bosnia and Herzegovina, represents an important starting point for building a sustainable nutritional surveillance system for the country. The cost-effective, low-burden approach to dietary surveillance described here could be applied in other low- and middle-income countries, many of which already carry out regular economic surveys.

Les systèmes nationaux de surveillance alimentaire sont nécessaires pour contrôler la consommation par la population des aliments et nutriments liés à la santé et aux maladies, mais aussi pour réaliser les objectifs nationaux et internationaux relatifs à l'alimentation. Or, il n'existe aucun système de la sorte dans nombre de pays à revenu faible et intermédiaire. La conception d'un modèle de surveillance alimentaire pour la Bosnie-Herzégovine que nous décrivons ici permet de mieux comprendre la faisabilité et la durabilité des systèmes de surveillance alimentaire dans les régions aux ressources limitées et illustre les défis à relever. En 2016, une enquête sur l'alimentation a été menée pendant une année, en collaboration avec l'institut national de la statistique de Bosnie-Herzégovine, auprès d'un sous-échantillon de ménages qui avaient pris part à l'enquête nationale de 2015 sur le budget des ménages. Les enquêteurs ont collecté des informations sur le mode de vie, des données anthropométriques et des données de santé, et les participants ont répondu à deux questionnaires fondés sur le rappel de leur consommation au cours des dernières 24 heures. Cette enquête a inclus un échantillon représentatif de 853 participants et a été efficacement menée par une petite équipe de personnes extrêmement motivées et bien formées. La réalisation d'une enquête de grande qualité sur l'alimentation s'est avérée faisable, malgré des ressources limitées. Par ailleurs, la possibilité de relier les données concernant les consommations alimentaires et les données des enquêtes régulièrement menéessur les ménages a fourni un moyen efficace d'associer les variables relatives à l'alimentation avec les déterminants socioéconomiques de la santé. Cette enquête sur l'alimentation (la toute première menée par un institut officiel en Bosnie-Herzégovine) constitue un bon point de départ pour l'élaboration d'un système de surveillance nutritionnelle durable pour le pays. L'approche de la surveillance alimentaire décrite ici, qui s'est avérée rentable et relativement peu pesante, pourrait être appliquée dans d'autres pays à revenu faible et intermédiaire, dont la plupart réalisent déjà régulièrement des enquêtes économiques.

Los sistemas nacionales de vigilancia de la alimentación son necesarios para controlar la ingesta de alimentos y nutrientes asociados con la salud y las enfermedades, así como para alcanzar los objetivos alimentarios nacionales y mundiales. Sin embargo, estos sistemas no existen en muchos países de ingresos bajos y medios. La elaboración de un modelo de vigilancia alimentaria para Bosnia y Herzegovina, que se describe aquí, permite comprender mejor la viabilidad y la sostenibilidad de los sistemas de vigilancia alimentaria en entornos con recursos limitados e ilustra los problemas que se plantean. En 2016, se inició una encuesta alimentaria de un año de duración en colaboración con el Instituto de Estadística del país a partir de una submuestra de hogares que participaron en la Encuesta nacional de presupuestos familiares de 2015. Los entrevistadores recopilaron datos de estilo de vida, antropométricos y de salud y los participantes respondieron a dos cuestionarios de recordatorio alimentario de 24 horas. La encuesta incluyó una muestra representativa de 853 participantes y fue realizada eficazmente por un pequeño equipo de personal altamente motivado y bien capacitado. La realización de una encuesta alimentaria de alta calidad resultó factible a pesar de la escasez de recursos. Además, la capacidad de vincular la ingesta alimentaria con los datos de las encuestas periódicas en los hogares era una manera eficaz de asociar las variables alimentarias con los factores socioeconómicos determinantes de la salud. Esta encuesta sobre la alimentación, la primera realizada por una institución oficial de Bosnia y Herzegovina, representa un punto de partida importante para la creación de un sistema sostenible de vigilancia alimentaria para el país. El enfoque rentable y de baja carga de la vigilancia alimentaria que aquí se describe podría aplicarse en otros países de ingresos bajos y medios, muchos de los cuales ya llevan a cabo encuestas económicas periódicas.

Demographic and socio-economic predictors of diet quality among adults in Bosnia and Herzegovina.

OBJECTIVE: To evaluate associations of demographic and socio-economic factors with diet quality among population subgroups in Bosnia and Herzegovina (B&H). DESIGN: A cross-sectional analysis of 2017 B&H dietary survey data. Diet quality was assessed by the Prime Diet Quality Score (PDQS) utilizing data from two non-consecutive 24 h diet recalls. Socio-economic variables were extracted from the 2015 B&H Household Budget Survey. Homogeneity of means across population subgroups was evaluated using multivariable regression. SETTING: B&H population survey. PARTICIPANTS: A population-based sample of 853 adults. RESULTS: The mean PDQS was 15·8 (range 7-28 out of a possible 42 points). In general, Bosnian adults had low PDQS due to high intakes of refined grains, high-fat dairy and processed meats, and low intakes of whole grains, nuts and fish. The PDQS was significantly higher (P < 0·0001) among older individuals (17·0) compared with those in the youngest group (14·5), among individuals living in the central and northern regions (16·5) compared with those living in the south (15·1; P < 0·0001), and among people who are married/cohabitating (16·1) v. single (14·8; P = 0·02). In energy-adjusted models, socio-economic status (P = 0·04) and tertiles of household spending (P = 0·002) were inversely associated with the PDQS. CONCLUSIONS: Diet quality in this population was low. Young and middle-aged individuals, singles and those living in the south had significantly lower quality diets compared with other subgroups. Public health action is needed to promote higher consumption of whole grains, nuts and fish, and a higher variety of fruits and vegetables.

Fathers' Representation in Observational Studies on Parenting and Childhood Obesity: A Systematic Review and Content Analysis.

BACKGROUND: The involvement of fathers in caregiving has increased substantially over the past 30 years. Yet in child and adolescent psychopathology, few studies include fathers as research participants and few present results for fathers separate from those for mothers. We test for the first time whether a similar pattern exists in research on parenting and childhood obesity. OBJECTIVES: To conduct a systematic review and quantitative content analysis of observational studies on parenting and childhood obesity to (1) document the inclusion of fathers, relative to mothers, as research participants and (2) examine characteristics of studies that did and did not include fathers. This study presents new data on the number and gender of parent research participants. SEARCH METHODS: We searched title, abstract, and Medical Subject Headings term fields in 5 research databases (PubMed, EMBASE, Academic Search Premier, PsycINFO, and CINAHL) using terms combining parents or parenting (e.g., mother, father, caregiver, parenting style, food parenting) and obesity (e.g., obesity, body weight, overweight) or obesity-related lifestyle behaviors (e.g., diet, snacking, physical activity, outdoor play, exercise, media use). SELECTION CRITERIA: We identified and screened studies as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) published between January 2009 and December 2015, examining links between parenting and childhood obesity, including parents or caregivers as research participants, and written in English. We excluded interventions, nonhuman studies, dissertations, conference abstracts, and studies on youths with specific medical conditions. Of 5557 unique studies, 667 studies were eligible. DATA COLLECTION AND ANALYSIS: For each of the 667 studies, 4 coders were trained to code characteristics of the study (e.g., publication year, geographic region, journal, study focus) and parent research participants (e.g., parent gender, demographic background, biological relationship with child, and residential status). We established intercoder reliability before coding the full sample of studies (mean Krippendorf's alpha = .79; average percentage agreement = 94%). MAIN RESULTS: Of the studies, 1% included only fathers. By contrast, 36% included only mothers. Although slightly more than 50% of studies (n = 347) included at least 1 father, only 57 studies reported results for fathers separate from those for mothers. When we combined them with studies including only fathers, 10% of studies overall reported results for fathers. Samples sizes of fathers were small compared with mothers. Of studies with fathers, 59% included 50 or fewer fathers, whereas 22% of studies with mothers included 50 or fewer mothers. The mean sample size for fathers across all eligible studies was 139, compared with 672 for mothers. Overall, fathers represented 17% of parent participants across all eligible studies. CONCLUSIONS: This study unequivocally demonstrates that fathers are underrepresented in recent observational research on parenting and childhood obesity. Public health implications. The underrepresentation of fathers in obesity research compromises the development of effective family interventions for childhood obesity prevention. Targeted opportunities and incentives are needed to support research with fathers.

A systematic review of media parenting in the context of childhood obesity research.

BACKGROUND: We conducted a systematic review to obtain studies on childhood obesity and parenting published between 2009 and 2015, and draw out those studies with a particular focus on media parenting. Our analysis addresses two major aims: 1) to describe how media use and media-related parenting practices and skills are operationalized in studies and 2) to explore whether studies measured ecological factors (e.g. individual-, family-, and community-level factors), which could be associated with media parenting practices. METHODS: Using a standardized, multi-stage process, we identified and screened articles focused on parenting and childhood obesity (N = 667). Studies were eligible for this analysis if they measured media parenting and/or the home media environment, resulting in a sample of 103 studies. We used quantitative content analysis to code the full text articles for content related to our study aims; analyses were performed using SAS 9.4. RESULTS: Seventy nine percent of studies measured media use, 82 % measured media parenting, and 65 % measured the home media environment. Studies measuring media use focused on a limited number of devices; while all studies measured child/parent use of televisions, only 3 % measured use of smartphones, 1 % measured use of laptops, and no studies measured use of tablets. Measures of parenting practices focused largely on rules specific to limiting screen time. Although 60 % of studies measured at least one ecological factor, child-specific and neighborhood/community-level factors were rarely measured. CONCLUSIONS: More detailed measurements of media use that reflects current technology trends and diverse contexts of use are needed to better understand media use and parent regulation of child media exposure. Measures of the ecological context can more fully assess factors impacting media parenting and, subsequently, child risk for overweight and obesity.

Development of the VEGANScreener, a Tool for a Quick Diet Quality Assessment among Vegans in Europe.

BACKGROUND: Plant-based diets are not inherently healthy. Similar to omnivorous diets, they may contain excessive amounts of sugar, sodium, and saturated fats, or lack diversity. Moreover, vegans might be at risk of inadequate intake of certain vitamins and minerals commonly found in foods that they avoid. We developed the VEGANScreener, a tool designed to assess the diet quality of vegans in Europe. METHODS: Our approach combined best practices in developing diet quality metrics with scale development approaches and involved the following: (a) narrative literature synthesis, (b) evidence evaluation by an international panel of experts, and (c) translation of evidence into a diet screener. We employed a modified Delphi technique to gather opinions from an international expert panel. RESULTS: Twenty-five experts in the fields of nutrition, epidemiology, preventive medicine, and diet assessment participated in the first round, and nineteen participated in the subsequent round. Initially, these experts provided feedback on a pool of 38 proposed items from the literature review. Consequently, 35 revised items, with 17 having multiple versions, were suggested for further consideration. In the second round, 29 items were retained, and any residual issues were addressed in the final consensus meeting. The ultimate screener draft encompassed 29 questions, with 17 focusing on foods and nutrients to promote, and 12 addressing foods and nutrients to limit. The screener contained 24 food-based and 5 nutrient-based questions. CONCLUSIONS: We elucidated the development process of the VEGANScreener, a novel diet quality screener for vegans. Future endeavors involve contrasting the VEGANScreener against benchmark diet assessment methodologies and nutritional biomarkers and testing its acceptance. Once validated, this instrument holds potential for deployment as a self-assessment application for vegans and as a preliminary dietary screening and counseling tool in healthcare settings.

Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring.

BACKGROUND: Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. OBJECTIVE: The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. DESIGN: A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. PARTICIPANTS/SETTING: The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. MAIN OUTCOME MEASURES: All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. STATISTICAL ANALYSES: Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. RESULTS: Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82). CONCLUSIONS: The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.

Food Insecurity and Less Frequent Cooking Dinner at Home Are Associated with Lower Diet Quality in a National Sample of Low-Income Adults in the United States during the Initial Months of the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Food insecurity is a critical public health problem in the United States that has been associated with poor diet quality. Cooking dinner more frequently is associated with better diet quality. OBJECTIVE: This study aimed to examine how food insecurity and dinner cooking frequency are associated with diet quality during the initial months of the coronavirus disease 2019 pandemic. DESIGN: This cross-sectional study analyzed data from a national web-based survey (June 23 to July 1, 2020). PARTICIPANTS/SETTING: Participants were 1,739 low-income (<250% of the federal poverty level) adults in the United States. MAIN OUTCOME MEASURES: The outcome was diet quality, measured by the Prime Diet Quality Score (PDQS-30D). The PDQS-30D is a food frequency questionnaire-based, 22-component diet quality index. STATISTICAL ANALYSES PERFORMED: Food security status (high, marginal, low, or very low) and frequency of cooking dinner (7, 5 to 6, 3 to 4, or 0 to 2 times/week) were evaluated in relation to PDQS-30D scores (possible range = zero to 126) in age- and sex and gender-, and fully adjusted linear regression models. Postestimation margins were used to predict mean PDQS-30D score by food security status and dinner cooking frequency. The interaction between food security status and frequency of cooking dinner was also tested. RESULTS: Overall, the mean PDQS-30D score was 51.9 ± 11 points (possible range = zero to 126). The prevalence of food insecurity (low/very low) was 43%, 37% of the sample cooked 7 times/week and 15% cooked 0 to 2 times/week. Lower food security and less frequent cooking dinner were both associated with lower diet quality. Very low food security was associated with a 3.2-point lower PDQS-30D score (95% CI -4.6 to -1.8) compared with those with high food security. Cooking dinner 0 to 2 times/week was associated with a 4.4-point lower PDQS-30D score (95% CI -6.0 to -2.8) compared with cooking 7 times/week. The relationship between food insecurity and diet quality did not differ based on cooking dinner frequency. CONCLUSIONS: During the initial months of the coronavirus disease 2019 pandemic food insecurity and less frequently cooking dinner at home were both associated with lower diet quality among low-income Americans. More research is needed to identify and address barriers to low-income households' ability to access, afford and prepare enough nutritious food for a healthy diet.

Estimating national and subnational nutrient intake distributions of global diets.

BACKGROUND: Access to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available. OBJECTIVES: We sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available. METHODS: We compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package-nutriR-to make these distributions freely available for users to apply in their own analyses. RESULTS: Usual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes. CONCLUSIONS: The shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.

Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women.

BACKGROUND: Valid and efficient tools for measuring and tracking diet quality globally are lacking. OBJECTIVE: The objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment. DESIGN: Two screener versions were designed using Prime Diet Quality Score (PDQS), one in a 24-hour recall (PDQS-24HR) and another in a 30-day (PDQS-30D) food frequency format. Participants completed two 24-hour diet recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2 web-based diet quality questionnaires 7 to 30 days apart in April and May 2019. Both dichotomous/trichotomous and granular scoring versions were tried for each screener. PARTICIPANTS/SETTING: The study included 290 nonpregnant, nonlactating US women (mean age ± standard deviation 41 ± 11 years) recruited via Amazon Mechanical Turk. MAIN OUTCOME MEASURES: The main outcome measures were Spearman rank correlation coefficients and linear regression beta-coefficients between ASA24 nutrient intakes from foods and beverages and PDQS values. STATISTICAL ANALYSES PERFORMED: The Spearman rank correlation and linear regression were used to evaluate associations of the PDQS values with ASA24 nutrient intakes from food, both crude and energy-adjusted. Correlations were de-attenuated for within-person variation in 24-hour recalls. Wolfe's test was used to compare correlations of the 2 screening instruments (PDQS-24HR and PDQS-30D) with the ASA24. Associations between the ASA24 Healthy Eating Index 2015 and the PDQS values were also evaluated. RESULTS: Positive, statistically significant rank correlations between the PDQS-24HR values and energy-adjusted nutrients from ASA24 for fiber (r = 0.53), magnesium (r = 0.51), potassium (r = 0.48), vitamin E (r = 0.40), folate (r = 0.37), vitamin C (r = 0.36), vitamin A (r = 0.33), vitamin B6 (r = 0.31), zinc (r = 0.25), and iron (r = 0.21); and inverse correlations for saturated fatty acids (r = -0.19), carbohydrates (r = -0.22), and added sugar (r = -0.34) were observed. Correlations of nutrient intakes assessed by ASA24 with the PDQS-30D were not significantly different from those with the PDQS-24HR. Positive, statistically significant correlations between the ASA24 Healthy Eating Index 2015 and the PDQS-24HR (r = 0.61) and the PDQS-30D (r = 0.60) were also found. CONCLUSIONS: The results of an initial evaluation of the PDQS-based diet quality screeners are promising. Correlations and associations between the PDQS values and nutrient intakes were of acceptable strength and in the expected directions, and the PDQS values had moderately strong correlations with the total Healthy Eating Index 2015 score. Future work should include evaluating the screeners in other population groups, including men, and piloting it across low- and middle-income countries.

Fueling an epidemic of non-communicable disease in the Balkans: a nutritional survey of Bosnian adults.

OBJECTIVES: Dietary surveys are essential for guiding national efforts to reduce the burden of non-communicable disease, but individual-level dietary data are lacking in many low- and middle-income countries. We aimed to estimate the prevalence of inadequate and excessive intakes of specific nutrients in Bosnia and Herzegovina. METHODS: A dietary survey among 853 adults using two 24-h recalls. RESULTS: The majority of men (73%) and women (66%) were overweight/obese, and > 50% of participants had elevated blood pressure. Low intakes of N-3 polyunsaturated fatty acids, specifically α-linolenic acid (men: 94.4 mg/day among, women: 96.6 mg/day) and DHA + EPA (men: 18.2 mg/day, women: 16.0 mg/day), low fiber intake (women: 21.5 g/day), and high sodium (men: 3244 mg/day, women: 2291 mg/) and saturated fatty acids intakes (men: 29.2 g/day) were reported. There was also a suggestion of low intakes of vitamins A, B6, C and D (in both sexes), and of riboflavin, folate, B12 and calcium (in women). CONCLUSIONS: Our findings provide initial evidence on the Bosnian population's dietary habits and identify aspects that need attention. As the survey evolves into a continuing surveillance system, it will allow evaluation of dietary changes over time.

Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy.

BACKGROUND: Dietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN's Sustainable Development Goals, but they need to be rigorously evaluated. OBJECTIVE: To examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs). DESIGN: The analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses' Health Study II cohort (1991-2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs). RESULTS: Incident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR's of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR's of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS. CONCLUSIONS: MDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.